1. Field of the Invention
The present invention relates to a vaginal extender for use in performing various female pelvic surgeries, including laparoscopic hysterectomy, laparoscopically assisted vaginal hysterectomy, and other female pelvic laparoscopic procedures where removal of tissue specimens through a colpotomy incision is indicated.
2. Description of the Prior Art
Conventional hysterectomy surgical procedures typically involve one of four approaches--vaginal hysterectomy, total abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and laparoscopically assisted vaginal hysterectomy (LAVH). Vaginal, TLH and LAVH have become more popular among surgeons because these approaches are less invasive than TAH, with TLH being the least invasive approach. TLH is less invasive than LAVH because it avoids the trauma normally caused by the expansion induced to the vaginal area to permit access of the surgeons hands to the cervical area. Unless medical indications require TAH (such as in the case of tumor removal and the associated need to avoid cell spillage), vaginal, TLH and LAVH are usually viewed as more preferable because each is less invasive when compared to major abdominal surgery. Thus, TLH and LAVH approaches usually result in shorter hospitalization and recovery times.
Difficulty, however, is encountered when employing vaginal, TLH and LAVH techniques due to inherent limitations on visibility, anatomical identification, and the ability to manipulate organs (especially the uterus). In the case of TLH, these limitations are particularly pronounced because of higher degree of difficulty in securing the uterine arteries and cardinal ligaments associated with this approach. A higher degree of surgical difficulty has been found empirically to give rise to an increased risk of inadvertent damage to or dissection into the bladder, ureters, uterine vessels and uterosacral and cardinal ligaments during the surgical procedure. Although the risk of inadvertent damage, for example, to the ureters can be minimized by the insertion of ureteral stints and/or peritoneal dissection to delineate ureter location, such techniques increase the complexity and the cost of the hysterectomy.
Other limitations associated with vaginal, TLH and LAVH surgical approaches, when compared to TAH, include limited exploratory ability and surgical control. Vaginal, TLH and LAVH approaches can also result in the unnecessary shortening of the vagina due to the limitations discussed above.
These difficulties and limitations have slowed the move by surgeons to use of the least invasive surgical approach (i.e., TLH), leading most gynecologists to perform LAVH.
Accordingly, there is a real and unsatisfied need in the surgical arts for a simplified total laparoscopic hysterectomy procedure to accurately secure uterine vessels and cardinal/uterosacral ligaments and to provide for a simplified colpotomy incision without ureteral dissection.